National Directory of Healthcare Providers & Services (NDH) Implementation Guide
1.0.0-ballot - ballot United States of America flag

National Directory of Healthcare Providers & Services (NDH) Implementation Guide, published by HL7 International / Patient Administration. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-us-ndh/ and changes regularly. See the Directory of published versions

Resource Profile: National Directory API InsurancePlan Profile

Official URL: http://hl7.org/fhir/us/ndh/StructureDefinition/ndh-ndapi-InsurancePlan Version: 1.0.0-ballot
Active as of 2025-02-07 Computable Name: NdhNdApiInsurancePlan

An InsurancePlan is a discrete package of health insurance coverage benefits that are offered under a particular network type. A given payer’s products typically differ by network type and/or covered benefits. A plan pairs a product’s covered benefits with the particular cost sharing structure offered to a consumer. A given product may comprise multiple plans (i.e. each plan offers different cost sharing requirements for the same set of covered benefits). InsurancePlan describes a health insurance offering comprised of a list of covered benefits (i.e. the product), costs associated with those benefits (i.e. the plan), and additional information about the offering, such as who it is owned and administered by, a coverage area, contact information, etc.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan C 0..* NdhInsurancePlan Details of a Health Insurance product/plan provided by an organization
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
dom-6: A resource should have narrative for robust management
ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one
network-or-NatlDirwork: If an insuranceplan does not define a network, then each plan must define one
plan-type-is-distinct: Each InsurancePlan.plan should have a distinct plan.type.
... meta SΣ 0..1 Meta Metadata about the resource
ele-1: All FHIR elements must have a @value or children
.... lastUpdated Σ 1..1 instant When the resource version last changed
ele-1: All FHIR elements must have a @value or children
.... profile Σ 1..1 canonical(StructureDefinition) Profiles this resource claims to conform to
ele-1: All FHIR elements must have a @value or children
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
ele-1: All FHIR elements must have a @value or children
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... usage-restriction 0..* Reference(NDH Base Restriction) {c} Usage Restriction
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-usage-restriction
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... verification-status S 1..1 CodeableConcept NDH Verification Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-verification-status
Binding: NDH Verification Status Value Set (extensible)
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... identifier SΣC 0..* Identifier Business Identifier for Product
ele-1: All FHIR elements must have a @value or children
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... identifier-status S 1..1 code NDH Identifier Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status
Binding: Identifier Status Value Set (required)
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... use ?!SΣ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


ele-1: All FHIR elements must have a @value or children
.... type SΣ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.


ele-1: All FHIR elements must have a @value or children
.... system SΣ 0..1 uri The namespace for the identifier value
ele-1: All FHIR elements must have a @value or children
Example General: http://www.acme.com/identifiers/patient
.... value SΣ 0..1 string The value that is unique
ele-1: All FHIR elements must have a @value or children
Example General: 123456
.... assigner SΣ 0..1 Reference(National Directory API Organization Profile) Organization that issued id (may be just text)
ele-1: All FHIR elements must have a @value or children
... status ?!SΣ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.


ele-1: All FHIR elements must have a @value or children
Fixed Value: active
... type SΣ 1..1 CodeableConcept Product Type
Binding: Insurance Product Type (extensible)
ele-1: All FHIR elements must have a @value or children
... name SΣC 0..1 string Official name
ele-1: All FHIR elements must have a @value or children
... alias S 0..* string Alternate names
ele-1: All FHIR elements must have a @value or children
... period S 0..1 Period When the product is available
ele-1: All FHIR elements must have a @value or children
... ownedBy SΣ 1..1 Reference(National Directory API Organization Profile) Plan issuer
ele-1: All FHIR elements must have a @value or children
... administeredBy SΣ 1..1 Reference(National Directory API Organization Profile) Product administrator
ele-1: All FHIR elements must have a @value or children
... coverageArea SΣ 0..* Reference(National Directory API Location Profile) Where product applies
ele-1: All FHIR elements must have a @value or children
... contact S 0..* BackboneElement Contact for the product
ele-1: All FHIR elements must have a @value or children
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... purpose S 0..1 CodeableConcept The type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.


ele-1: All FHIR elements must have a @value or children
.... name S 0..1 HumanName A name associated with the contact
ele-1: All FHIR elements must have a @value or children
..... use ?!SΣ 0..1 code usual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.


ele-1: All FHIR elements must have a @value or children
..... text SΣ 0..1 string Text representation of the full name
ele-1: All FHIR elements must have a @value or children
..... family SΣ 0..1 string Family name (often called 'Surname')
ele-1: All FHIR elements must have a @value or children
..... given SΣ 0..* string Given names (not always 'first'). Includes middle names
ele-1: All FHIR elements must have a @value or children
This repeating element order: Given Names appear in the correct order for presenting the name
..... prefix SΣ 0..* string Parts that come before the name
ele-1: All FHIR elements must have a @value or children
This repeating element order: Prefixes appear in the correct order for presenting the name
..... suffix SΣ 0..* string Parts that come after the name
ele-1: All FHIR elements must have a @value or children
This repeating element order: Suffixes appear in the correct order for presenting the name
..... period SΣ 0..1 Period Time period when name was/is in use
ele-1: All FHIR elements must have a @value or children
.... telecom S 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
ele-1: All FHIR elements must have a @value or children
..... Slices for extension Content/Rules for all slices
...... contactpoint-availabletime S 0..* (Complex) NDH Contactpoint Availabletime
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-contactpoint-availabletime
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
...... via-intermediary S 0..1 Reference(NDH Base PractitionerRole | NDH Base OrganizationAffiliation Profile | NDH Base Location Profile | NDH Base Organization Profile) NDH Via Intermediary
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-via-intermediary
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... system SΣC 0..1 code phone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.


ele-1: All FHIR elements must have a @value or children
..... value SΣ 0..1 string The actual contact point details
ele-1: All FHIR elements must have a @value or children
..... use ?!SΣ 0..1 code home | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required): Use of contact point.


ele-1: All FHIR elements must have a @value or children
..... rank SΣ 0..1 positiveInt Specify preferred order of use (1 = highest)
ele-1: All FHIR elements must have a @value or children
... endpoint S 0..* Reference(National Directory API Endpoint Profile) Technical endpoint
ele-1: All FHIR elements must have a @value or children
... network S 0..* Reference(National Directory API Network Profile) What networks are Included
ele-1: All FHIR elements must have a @value or children
... coverage S 0..* BackboneElement Coverage details
ele-1: All FHIR elements must have a @value or children
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... type S 1..1 CodeableConcept Type of coverage
Binding: Insurance Coverage Type (extensible)
ele-1: All FHIR elements must have a @value or children
.... network S 0..* Reference(National Directory API Network Profile) What networks provide coverage
ele-1: All FHIR elements must have a @value or children
.... benefit S 1..* BackboneElement List of benefits
ele-1: All FHIR elements must have a @value or children
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... type S 1..1 CodeableConcept Type of benefit
Binding: NDH Benefit Type Value Set (extensible)
ele-1: All FHIR elements must have a @value or children
..... requirement S 0..1 string Referral requirements
ele-1: All FHIR elements must have a @value or children
..... limit S 0..* BackboneElement Benefit limits
ele-1: All FHIR elements must have a @value or children
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
...... value S 0..1 Quantity Maximum value allowed
ele-1: All FHIR elements must have a @value or children
...... code S 0..1 CodeableConcept Benefit limit details
ele-1: All FHIR elements must have a @value or children
... plan S 0..* BackboneElement Cost sharing details for the plan
ele-1: All FHIR elements must have a @value or children
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... identifier SΣ 0..* Identifier Business Identifier for Product
ele-1: All FHIR elements must have a @value or children
..... Slices for extension Content/Rules for all slices
...... identifier-status S 0..1 code NDH Identifier Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status
Binding: Identifier Status Value Set (required)
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... use ?!SΣ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


ele-1: All FHIR elements must have a @value or children
..... type SΣ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.


ele-1: All FHIR elements must have a @value or children
..... system SΣ 0..1 uri The namespace for the identifier value
ele-1: All FHIR elements must have a @value or children
Example General: http://www.acme.com/identifiers/patient
..... value SΣ 0..1 string The value that is unique
ele-1: All FHIR elements must have a @value or children
Example General: 123456
..... period SΣ 0..1 Period Time period when id is/was valid for use
ele-1: All FHIR elements must have a @value or children
..... assigner SΣ 0..1 Reference(National Directory API Organization Profile) Organization that issued id (may be just text)
ele-1: All FHIR elements must have a @value or children
.... type S 0..1 CodeableConcept Categorization of the cost sharing for the plan
Binding: Insuranceplan Plan Type (extensible)
ele-1: All FHIR elements must have a @value or children
.... coverageArea SΣ 0..* Reference(National Directory API Location Profile) Where product applies
ele-1: All FHIR elements must have a @value or children
.... network S 0..* Reference(National Directory API Network Profile) What networks provide coverage
ele-1: All FHIR elements must have a @value or children
.... generalCost S 0..* BackboneElement Overall costs
ele-1: All FHIR elements must have a @value or children
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... type S 0..1 CodeableConcept Type of cost
ele-1: All FHIR elements must have a @value or children
..... groupSize S 0..1 positiveInt Number of enrollees
ele-1: All FHIR elements must have a @value or children
..... cost S 0..1 Money Cost value
ele-1: All FHIR elements must have a @value or children
..... comment S 0..1 string Additional cost information
ele-1: All FHIR elements must have a @value or children
.... specificCost S 0..* BackboneElement Specific costs
ele-1: All FHIR elements must have a @value or children
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... category S 1..1 CodeableConcept General category of benefit
ele-1: All FHIR elements must have a @value or children
..... benefit S 0..* BackboneElement Benefits list
ele-1: All FHIR elements must have a @value or children
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
...... type S 1..1 CodeableConcept Type of specific benefit
ele-1: All FHIR elements must have a @value or children
...... cost S 0..* BackboneElement List of the costs
ele-1: All FHIR elements must have a @value or children
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
....... type S 1..1 CodeableConcept Type of cost
ele-1: All FHIR elements must have a @value or children
....... applicability S 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.


ele-1: All FHIR elements must have a @value or children
....... qualifiers S 0..* CodeableConcept Additional information about the cost
ele-1: All FHIR elements must have a @value or children
....... value S 0..1 Quantity The actual cost value
ele-1: All FHIR elements must have a @value or children

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
InsurancePlan.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
InsurancePlan.identifier.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
InsurancePlan.statusrequiredFixed Value: active
http://hl7.org/fhir/ValueSet/publication-status|4.0.1
from the FHIR Standard
InsurancePlan.typeextensibleInsuranceProductType
http://terminology.hl7.org/ValueSet/insurance-product-type
InsurancePlan.contact.purposeextensibleContactEntityType
http://hl7.org/fhir/ValueSet/contactentity-type
from the FHIR Standard
InsurancePlan.contact.name.userequiredNameUse
http://hl7.org/fhir/ValueSet/name-use|4.0.1
from the FHIR Standard
InsurancePlan.contact.telecom.systemrequiredContactPointSystem
http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1
from the FHIR Standard
InsurancePlan.contact.telecom.userequiredContactPointUse
http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1
from the FHIR Standard
InsurancePlan.coverage.typeextensibleInsuranceCoverageType
http://terminology.hl7.org/ValueSet/insurance-coverage-type
InsurancePlan.coverage.benefit.typeextensibleNdhBenefitTypeVS
http://hl7.org/fhir/us/ndh/ValueSet/NdhBenefitTypeVS
from this IG
InsurancePlan.plan.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
InsurancePlan.plan.identifier.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
InsurancePlan.plan.typeextensibleInsuranceplanPlanType
http://terminology.hl7.org/ValueSet/insuranceplan-plan-type
InsurancePlan.plan.specificCost.benefit.cost.applicabilityrequiredBenefitCostApplicability
http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1
from the FHIR Standard

This structure is derived from NdhInsurancePlan

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan NdhInsurancePlan
... meta S 0..1 Meta Metadata about the resource
.... profile 1..1 canonical(StructureDefinition) Profiles this resource claims to conform to
... extension 1..* Extension Extension
... Slices for extension Content/Rules for all slices
.... extension:verification-status S 1..1 VerificationStatus NDH Verification Status
.... extension 1..* Extension Extension
.... Slices for extension Content/Rules for all slices
..... extension:identifier-status S 1..1 IdentifierStatus NDH Identifier Status
.... use S 0..1 code usual | official | temp | secondary | old (If known)
.... type S 0..1 CodeableConcept Description of identifier
.... system S 0..1 uri The namespace for the identifier value
.... value S 0..1 string The value that is unique
.... assigner S 0..1 Reference(National Directory API Organization Profile) Organization that issued id (may be just text)
... alias S 0..* string Alternate names
... period S 0..1 Period When the product is available
... ownedBy S 1..1 Reference(National Directory API Organization Profile) Plan issuer
... administeredBy S 1..1 Reference(National Directory API Organization Profile) Product administrator
... coverageArea 0..* Reference(National Directory API Location Profile) Where product applies
... contact S 0..* BackboneElement Contact for the product
.... purpose S 0..1 CodeableConcept The type of contact
.... name S 0..1 HumanName A name associated with the contact
..... use S 0..1 code usual | official | temp | nickname | anonymous | old | maiden
..... text S 0..1 string Text representation of the full name
..... family S 0..1 string Family name (often called 'Surname')
..... given S 0..* string Given names (not always 'first'). Includes middle names
..... prefix S 0..* string Parts that come before the name
..... suffix S 0..* string Parts that come after the name
..... period S 0..1 Period Time period when name was/is in use
.... telecom S 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
..... Slices for extension Content/Rules for all slices
...... extension:contactpoint-availabletime S 0..* ContactPointAvailableTime NDH Contactpoint Availabletime
...... extension:via-intermediary S 0..1 ViaIntermediary NDH Via Intermediary
..... system S 0..1 code phone | fax | email | pager | url | sms | other
..... value S 0..1 string The actual contact point details
..... use S 0..1 code home | work | temp | old | mobile - purpose of this contact point
..... rank S 0..1 positiveInt Specify preferred order of use (1 = highest)
... endpoint S 0..* Reference(National Directory API Endpoint Profile) Technical endpoint
... network 0..* Reference(National Directory API Network Profile) What networks are Included
... coverage S 0..* BackboneElement Coverage details
.... type S 1..1 CodeableConcept Type of coverage
.... network 0..* Reference(National Directory API Network Profile) What networks provide coverage
.... benefit S 1..* BackboneElement List of benefits
..... type S 1..1 CodeableConcept Type of benefit
..... requirement S 0..1 string Referral requirements
..... limit S 0..* BackboneElement Benefit limits
...... value S 0..1 Quantity Maximum value allowed
...... code S 0..1 CodeableConcept Benefit limit details
... plan S 0..* BackboneElement Cost sharing details for the plan
.... identifier S 0..* Identifier Business Identifier for Product
..... Slices for extension Content/Rules for all slices
...... extension:identifier-status S 0..1 IdentifierStatus NDH Identifier Status
..... use S 0..1 code usual | official | temp | secondary | old (If known)
..... type S 0..1 CodeableConcept Description of identifier
..... system S 0..1 uri The namespace for the identifier value
..... value S 0..1 string The value that is unique
..... period S 0..1 Period Time period when id is/was valid for use
..... assigner S 0..1 Reference(National Directory API Organization Profile) Organization that issued id (may be just text)
.... type S 0..1 CodeableConcept Categorization of the cost sharing for the plan
.... coverageArea S 0..* Reference(National Directory API Location Profile) Where product applies
.... network S 0..* Reference(National Directory API Network Profile) What networks provide coverage
.... generalCost S 0..* BackboneElement Overall costs
..... type S 0..1 CodeableConcept Type of cost
..... groupSize S 0..1 positiveInt Number of enrollees
..... cost S 0..1 Money Cost value
..... comment S 0..1 string Additional cost information
.... specificCost S 0..* BackboneElement Specific costs
..... category S 1..1 CodeableConcept General category of benefit
..... benefit S 0..* BackboneElement Benefits list
...... type S 1..1 CodeableConcept Type of specific benefit
...... cost S 0..* BackboneElement List of the costs
....... type S 1..1 CodeableConcept Type of cost
....... applicability S 0..1 CodeableConcept in-network | out-of-network | other
....... qualifiers S 0..* CodeableConcept Additional information about the cost
....... value S 0..1 Quantity The actual cost value

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan C 0..* NdhInsurancePlan Details of a Health Insurance product/plan provided by an organization
ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one
network-or-NatlDirwork: If an insuranceplan does not define a network, then each plan must define one
plan-type-is-distinct: Each InsurancePlan.plan should have a distinct plan.type.
... id Σ 0..1 id Logical id of this artifact
... meta SΣ 0..1 Meta Metadata about the resource
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... versionId Σ 0..1 id Version specific identifier
.... lastUpdated Σ 1..1 instant When the resource version last changed
.... source Σ 0..1 uri Identifies where the resource comes from
.... profile Σ 1..1 canonical(StructureDefinition) Profiles this resource claims to conform to
.... security Σ 0..* Coding Security Labels applied to this resource
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... tag Σ 0..* Coding Tags applied to this resource
Binding: CommonTags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".


... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
... contained 0..* Resource Contained, inline Resources
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
.... usage-restriction 0..* Reference(NDH Base Restriction) {c} Usage Restriction
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-usage-restriction
.... verification-status S 1..1 CodeableConcept NDH Verification Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-verification-status
Binding: NDH Verification Status Value Set (extensible)
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣC 0..* Identifier Business Identifier for Product
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
..... identifier-status S 1..1 code NDH Identifier Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status
Binding: Identifier Status Value Set (required)
.... use ?!SΣ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

.... type SΣ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

.... system SΣ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
.... value SΣ 0..1 string The value that is unique
Example General: 123456
.... period Σ 0..1 Period Time period when id is/was valid for use
.... assigner SΣ 0..1 Reference(National Directory API Organization Profile) Organization that issued id (may be just text)
... status ?!SΣ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.


Fixed Value: active
... type SΣ 1..1 CodeableConcept Product Type
Binding: Insurance Product Type (extensible)
... name SΣC 0..1 string Official name
... alias S 0..* string Alternate names
... period S 0..1 Period When the product is available
... ownedBy SΣ 1..1 Reference(National Directory API Organization Profile) Plan issuer
... administeredBy SΣ 1..1 Reference(National Directory API Organization Profile) Product administrator
... coverageArea SΣ 0..* Reference(National Directory API Location Profile) Where product applies
... contact S 0..* BackboneElement Contact for the product
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... purpose S 0..1 CodeableConcept The type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.

.... name S 0..1 HumanName A name associated with the contact
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!SΣ 0..1 code usual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.

..... text SΣ 0..1 string Text representation of the full name
..... family SΣ 0..1 string Family name (often called 'Surname')
..... given SΣ 0..* string Given names (not always 'first'). Includes middle names
This repeating element order: Given Names appear in the correct order for presenting the name
..... prefix SΣ 0..* string Parts that come before the name
This repeating element order: Prefixes appear in the correct order for presenting the name
..... suffix SΣ 0..* string Parts that come after the name
This repeating element order: Suffixes appear in the correct order for presenting the name
..... period SΣ 0..1 Period Time period when name was/is in use
.... telecom S 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... contactpoint-availabletime S 0..* (Complex) NDH Contactpoint Availabletime
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-contactpoint-availabletime
...... via-intermediary S 0..1 Reference(NDH Base PractitionerRole | NDH Base OrganizationAffiliation Profile | NDH Base Location Profile | NDH Base Organization Profile) NDH Via Intermediary
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-via-intermediary
..... system SΣC 0..1 code phone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.

..... value SΣ 0..1 string The actual contact point details
..... use ?!SΣ 0..1 code home | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required): Use of contact point.

..... rank SΣ 0..1 positiveInt Specify preferred order of use (1 = highest)
..... period Σ 0..1 Period Time period when the contact point was/is in use
.... address 0..1 Address Visiting or postal addresses for the contact
... endpoint S 0..* Reference(National Directory API Endpoint Profile) Technical endpoint
... network S 0..* Reference(National Directory API Network Profile) What networks are Included
... coverage S 0..* BackboneElement Coverage details
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... type S 1..1 CodeableConcept Type of coverage
Binding: Insurance Coverage Type (extensible)
.... network S 0..* Reference(National Directory API Network Profile) What networks provide coverage
.... benefit S 1..* BackboneElement List of benefits
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type S 1..1 CodeableConcept Type of benefit
Binding: NDH Benefit Type Value Set (extensible)
..... requirement S 0..1 string Referral requirements
..... limit S 0..* BackboneElement Benefit limits
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... value S 0..1 Quantity Maximum value allowed
...... code S 0..1 CodeableConcept Benefit limit details
... plan S 0..* BackboneElement Cost sharing details for the plan
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... identifier SΣ 0..* Identifier Business Identifier for Product
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... identifier-status S 0..1 code NDH Identifier Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status
Binding: Identifier Status Value Set (required)
..... use ?!SΣ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type SΣ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system SΣ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣ 0..1 string The value that is unique
Example General: 123456
..... period SΣ 0..1 Period Time period when id is/was valid for use
..... assigner SΣ 0..1 Reference(National Directory API Organization Profile) Organization that issued id (may be just text)
.... type S 0..1 CodeableConcept Categorization of the cost sharing for the plan
Binding: Insuranceplan Plan Type (extensible)
.... coverageArea SΣ 0..* Reference(National Directory API Location Profile) Where product applies
.... network S 0..* Reference(National Directory API Network Profile) What networks provide coverage
.... generalCost S 0..* BackboneElement Overall costs
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... type S 0..1 CodeableConcept Type of cost
..... groupSize S 0..1 positiveInt Number of enrollees
..... cost S 0..1 Money Cost value
..... comment S 0..1 string Additional cost information
.... specificCost S 0..* BackboneElement Specific costs
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... category S 1..1 CodeableConcept General category of benefit
..... benefit S 0..* BackboneElement Benefits list
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
...... type S 1..1 CodeableConcept Type of specific benefit
...... cost S 0..* BackboneElement List of the costs
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
....... type S 1..1 CodeableConcept Type of cost
....... applicability S 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.

....... qualifiers S 0..* CodeableConcept Additional information about the cost
....... value S 0..1 Quantity The actual cost value

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
InsurancePlan.meta.securityextensibleAll Security Labels
http://hl7.org/fhir/ValueSet/security-labels
from the FHIR Standard
InsurancePlan.meta.tagexampleCommonTags
http://hl7.org/fhir/ValueSet/common-tags
from the FHIR Standard
InsurancePlan.languagepreferredCommonLanguages
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
Additional Bindings Purpose
AllLanguages Max Binding
InsurancePlan.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
InsurancePlan.identifier.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
InsurancePlan.statusrequiredFixed Value: active
http://hl7.org/fhir/ValueSet/publication-status|4.0.1
from the FHIR Standard
InsurancePlan.typeextensibleInsuranceProductType
http://terminology.hl7.org/ValueSet/insurance-product-type
InsurancePlan.contact.purposeextensibleContactEntityType
http://hl7.org/fhir/ValueSet/contactentity-type
from the FHIR Standard
InsurancePlan.contact.name.userequiredNameUse
http://hl7.org/fhir/ValueSet/name-use|4.0.1
from the FHIR Standard
InsurancePlan.contact.telecom.systemrequiredContactPointSystem
http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1
from the FHIR Standard
InsurancePlan.contact.telecom.userequiredContactPointUse
http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1
from the FHIR Standard
InsurancePlan.coverage.typeextensibleInsuranceCoverageType
http://terminology.hl7.org/ValueSet/insurance-coverage-type
InsurancePlan.coverage.benefit.typeextensibleNdhBenefitTypeVS
http://hl7.org/fhir/us/ndh/ValueSet/NdhBenefitTypeVS
from this IG
InsurancePlan.plan.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
InsurancePlan.plan.identifier.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
InsurancePlan.plan.typeextensibleInsuranceplanPlanType
http://terminology.hl7.org/ValueSet/insuranceplan-plan-type
InsurancePlan.plan.specificCost.benefit.cost.applicabilityrequiredBenefitCostApplicability
http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1
from the FHIR Standard

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan C 0..* NdhInsurancePlan Details of a Health Insurance product/plan provided by an organization
dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
dom-6: A resource should have narrative for robust management
ipn-1: The organization SHALL at least have a name or an idendtifier, and possibly more than one
network-or-NatlDirwork: If an insuranceplan does not define a network, then each plan must define one
plan-type-is-distinct: Each InsurancePlan.plan should have a distinct plan.type.
... meta SΣ 0..1 Meta Metadata about the resource
ele-1: All FHIR elements must have a @value or children
.... lastUpdated Σ 1..1 instant When the resource version last changed
ele-1: All FHIR elements must have a @value or children
.... profile Σ 1..1 canonical(StructureDefinition) Profiles this resource claims to conform to
ele-1: All FHIR elements must have a @value or children
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
ele-1: All FHIR elements must have a @value or children
... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... usage-restriction 0..* Reference(NDH Base Restriction) {c} Usage Restriction
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-usage-restriction
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... verification-status S 1..1 CodeableConcept NDH Verification Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-verification-status
Binding: NDH Verification Status Value Set (extensible)
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
... identifier SΣC 0..* Identifier Business Identifier for Product
ele-1: All FHIR elements must have a @value or children
.... Slices for extension 1..* Extension Extension
Slice: Unordered, Open by value:url
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... identifier-status S 1..1 code NDH Identifier Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status
Binding: Identifier Status Value Set (required)
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... use ?!SΣ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


ele-1: All FHIR elements must have a @value or children
.... type SΣ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.


ele-1: All FHIR elements must have a @value or children
.... system SΣ 0..1 uri The namespace for the identifier value
ele-1: All FHIR elements must have a @value or children
Example General: http://www.acme.com/identifiers/patient
.... value SΣ 0..1 string The value that is unique
ele-1: All FHIR elements must have a @value or children
Example General: 123456
.... assigner SΣ 0..1 Reference(National Directory API Organization Profile) Organization that issued id (may be just text)
ele-1: All FHIR elements must have a @value or children
... status ?!SΣ 1..1 code draft | active | retired | unknown
Binding: PublicationStatus (required): The lifecycle status of an artifact.


ele-1: All FHIR elements must have a @value or children
Fixed Value: active
... type SΣ 1..1 CodeableConcept Product Type
Binding: Insurance Product Type (extensible)
ele-1: All FHIR elements must have a @value or children
... name SΣC 0..1 string Official name
ele-1: All FHIR elements must have a @value or children
... alias S 0..* string Alternate names
ele-1: All FHIR elements must have a @value or children
... period S 0..1 Period When the product is available
ele-1: All FHIR elements must have a @value or children
... ownedBy SΣ 1..1 Reference(National Directory API Organization Profile) Plan issuer
ele-1: All FHIR elements must have a @value or children
... administeredBy SΣ 1..1 Reference(National Directory API Organization Profile) Product administrator
ele-1: All FHIR elements must have a @value or children
... coverageArea SΣ 0..* Reference(National Directory API Location Profile) Where product applies
ele-1: All FHIR elements must have a @value or children
... contact S 0..* BackboneElement Contact for the product
ele-1: All FHIR elements must have a @value or children
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... purpose S 0..1 CodeableConcept The type of contact
Binding: ContactEntityType (extensible): The purpose for which you would contact a contact party.


ele-1: All FHIR elements must have a @value or children
.... name S 0..1 HumanName A name associated with the contact
ele-1: All FHIR elements must have a @value or children
..... use ?!SΣ 0..1 code usual | official | temp | nickname | anonymous | old | maiden
Binding: NameUse (required): The use of a human name.


ele-1: All FHIR elements must have a @value or children
..... text SΣ 0..1 string Text representation of the full name
ele-1: All FHIR elements must have a @value or children
..... family SΣ 0..1 string Family name (often called 'Surname')
ele-1: All FHIR elements must have a @value or children
..... given SΣ 0..* string Given names (not always 'first'). Includes middle names
ele-1: All FHIR elements must have a @value or children
This repeating element order: Given Names appear in the correct order for presenting the name
..... prefix SΣ 0..* string Parts that come before the name
ele-1: All FHIR elements must have a @value or children
This repeating element order: Prefixes appear in the correct order for presenting the name
..... suffix SΣ 0..* string Parts that come after the name
ele-1: All FHIR elements must have a @value or children
This repeating element order: Suffixes appear in the correct order for presenting the name
..... period SΣ 0..1 Period Time period when name was/is in use
ele-1: All FHIR elements must have a @value or children
.... telecom S 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
ele-1: All FHIR elements must have a @value or children
..... Slices for extension Content/Rules for all slices
...... contactpoint-availabletime S 0..* (Complex) NDH Contactpoint Availabletime
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-contactpoint-availabletime
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
...... via-intermediary S 0..1 Reference(NDH Base PractitionerRole | NDH Base OrganizationAffiliation Profile | NDH Base Location Profile | NDH Base Organization Profile) NDH Via Intermediary
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-via-intermediary
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... system SΣC 0..1 code phone | fax | email | pager | url | sms | other
Binding: ContactPointSystem (required): Telecommunications form for contact point.


ele-1: All FHIR elements must have a @value or children
..... value SΣ 0..1 string The actual contact point details
ele-1: All FHIR elements must have a @value or children
..... use ?!SΣ 0..1 code home | work | temp | old | mobile - purpose of this contact point
Binding: ContactPointUse (required): Use of contact point.


ele-1: All FHIR elements must have a @value or children
..... rank SΣ 0..1 positiveInt Specify preferred order of use (1 = highest)
ele-1: All FHIR elements must have a @value or children
... endpoint S 0..* Reference(National Directory API Endpoint Profile) Technical endpoint
ele-1: All FHIR elements must have a @value or children
... network S 0..* Reference(National Directory API Network Profile) What networks are Included
ele-1: All FHIR elements must have a @value or children
... coverage S 0..* BackboneElement Coverage details
ele-1: All FHIR elements must have a @value or children
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... type S 1..1 CodeableConcept Type of coverage
Binding: Insurance Coverage Type (extensible)
ele-1: All FHIR elements must have a @value or children
.... network S 0..* Reference(National Directory API Network Profile) What networks provide coverage
ele-1: All FHIR elements must have a @value or children
.... benefit S 1..* BackboneElement List of benefits
ele-1: All FHIR elements must have a @value or children
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... type S 1..1 CodeableConcept Type of benefit
Binding: NDH Benefit Type Value Set (extensible)
ele-1: All FHIR elements must have a @value or children
..... requirement S 0..1 string Referral requirements
ele-1: All FHIR elements must have a @value or children
..... limit S 0..* BackboneElement Benefit limits
ele-1: All FHIR elements must have a @value or children
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
...... value S 0..1 Quantity Maximum value allowed
ele-1: All FHIR elements must have a @value or children
...... code S 0..1 CodeableConcept Benefit limit details
ele-1: All FHIR elements must have a @value or children
... plan S 0..* BackboneElement Cost sharing details for the plan
ele-1: All FHIR elements must have a @value or children
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
.... identifier SΣ 0..* Identifier Business Identifier for Product
ele-1: All FHIR elements must have a @value or children
..... Slices for extension Content/Rules for all slices
...... identifier-status S 0..1 code NDH Identifier Status
URL: http://hl7.org/fhir/us/ndh/StructureDefinition/base-ext-identifier-status
Binding: Identifier Status Value Set (required)
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... use ?!SΣ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


ele-1: All FHIR elements must have a @value or children
..... type SΣ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.


ele-1: All FHIR elements must have a @value or children
..... system SΣ 0..1 uri The namespace for the identifier value
ele-1: All FHIR elements must have a @value or children
Example General: http://www.acme.com/identifiers/patient
..... value SΣ 0..1 string The value that is unique
ele-1: All FHIR elements must have a @value or children
Example General: 123456
..... period SΣ 0..1 Period Time period when id is/was valid for use
ele-1: All FHIR elements must have a @value or children
..... assigner SΣ 0..1 Reference(National Directory API Organization Profile) Organization that issued id (may be just text)
ele-1: All FHIR elements must have a @value or children
.... type S 0..1 CodeableConcept Categorization of the cost sharing for the plan
Binding: Insuranceplan Plan Type (extensible)
ele-1: All FHIR elements must have a @value or children
.... coverageArea SΣ 0..* Reference(National Directory API Location Profile) Where product applies
ele-1: All FHIR elements must have a @value or children
.... network S 0..* Reference(National Directory API Network Profile) What networks provide coverage
ele-1: All FHIR elements must have a @value or children
.... generalCost S 0..* BackboneElement Overall costs
ele-1: All FHIR elements must have a @value or children
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... type S 0..1 CodeableConcept Type of cost
ele-1: All FHIR elements must have a @value or children
..... groupSize S 0..1 positiveInt Number of enrollees
ele-1: All FHIR elements must have a @value or children
..... cost S 0..1 Money Cost value
ele-1: All FHIR elements must have a @value or children
..... comment S 0..1 string Additional cost information
ele-1: All FHIR elements must have a @value or children
.... specificCost S 0..* BackboneElement Specific costs
ele-1: All FHIR elements must have a @value or children
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
..... category S 1..1 CodeableConcept General category of benefit
ele-1: All FHIR elements must have a @value or children
..... benefit S 0..* BackboneElement Benefits list
ele-1: All FHIR elements must have a @value or children
...... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
...... type S 1..1 CodeableConcept Type of specific benefit
ele-1: All FHIR elements must have a @value or children
...... cost S 0..* BackboneElement List of the costs
ele-1: All FHIR elements must have a @value or children
....... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
ele-1: All FHIR elements must have a @value or children
ext-1: Must have either extensions or value[x], not both
....... type S 1..1 CodeableConcept Type of cost
ele-1: All FHIR elements must have a @value or children
....... applicability S 0..1 CodeableConcept in-network | out-of-network | other
Binding: BenefitCostApplicability (required): Whether the cost applies to in-network or out-of-network providers.


ele-1: All FHIR elements must have a @value or children
....... qualifiers S 0..* CodeableConcept Additional information about the cost
ele-1: All FHIR elements must have a @value or children
....... value S 0..1 Quantity The actual cost value
ele-1: All FHIR elements must have a @value or children

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
InsurancePlan.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
InsurancePlan.identifier.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
InsurancePlan.statusrequiredFixed Value: active
http://hl7.org/fhir/ValueSet/publication-status|4.0.1
from the FHIR Standard
InsurancePlan.typeextensibleInsuranceProductType
http://terminology.hl7.org/ValueSet/insurance-product-type
InsurancePlan.contact.purposeextensibleContactEntityType
http://hl7.org/fhir/ValueSet/contactentity-type
from the FHIR Standard
InsurancePlan.contact.name.userequiredNameUse
http://hl7.org/fhir/ValueSet/name-use|4.0.1
from the FHIR Standard
InsurancePlan.contact.telecom.systemrequiredContactPointSystem
http://hl7.org/fhir/ValueSet/contact-point-system|4.0.1
from the FHIR Standard
InsurancePlan.contact.telecom.userequiredContactPointUse
http://hl7.org/fhir/ValueSet/contact-point-use|4.0.1
from the FHIR Standard
InsurancePlan.coverage.typeextensibleInsuranceCoverageType
http://terminology.hl7.org/ValueSet/insurance-coverage-type
InsurancePlan.coverage.benefit.typeextensibleNdhBenefitTypeVS
http://hl7.org/fhir/us/ndh/ValueSet/NdhBenefitTypeVS
from this IG
InsurancePlan.plan.identifier.userequiredIdentifierUse
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
InsurancePlan.plan.identifier.typeextensibleIdentifier Type Codes
http://hl7.org/fhir/ValueSet/identifier-type
from the FHIR Standard
InsurancePlan.plan.typeextensibleInsuranceplanPlanType
http://terminology.hl7.org/ValueSet/insuranceplan-plan-type
InsurancePlan.plan.specificCost.benefit.cost.applicabilityrequiredBenefitCostApplicability
http://hl7.org/fhir/ValueSet/insuranceplan-applicability|4.0.1
from the FHIR Standard

Differential View

This structure is derived from NdhInsurancePlan

NameFlagsCard.TypeDescription & Constraintsdoco
.. InsurancePlan NdhInsurancePlan
... meta S 0..1 Meta Metadata about the resource
.... profile 1..1 canonical(StructureDefinition) Profiles this resource claims to conform to
... extension 1..* Extension Extension
... Slices for extension Content/Rules for all slices
.... extension:verification-status S 1..1 VerificationStatus NDH Verification Status
.... extension 1..* Extension Extension
.... Slices for extension Content/Rules for all slices
..... extension:identifier-status S 1..1 IdentifierStatus NDH Identifier Status
.... use S 0..1 code usual | official | temp | secondary | old (If known)
.... type S 0..1 CodeableConcept Description of identifier
.... system S 0..1 uri The namespace for the identifier value
.... value S 0..1 string The value that is unique
.... assigner S 0..1 Reference(National Directory API Organization Profile) Organization that issued id (may be just text)
... alias S 0..* string Alternate names
... period S 0..1 Period When the product is available
... ownedBy S 1..1 Reference(National Directory API Organization Profile) Plan issuer
... administeredBy S 1..1 Reference(National Directory API Organization Profile) Product administrator
... coverageArea 0..* Reference(National Directory API Location Profile) Where product applies
... contact S 0..* BackboneElement Contact for the product
.... purpose S 0..1 CodeableConcept The type of contact
.... name S 0..1 HumanName A name associated with the contact
..... use S 0..1 code usual | official | temp | nickname | anonymous | old | maiden
..... text S 0..1 string Text representation of the full name
..... family S 0..1 string Family name (often called 'Surname')
..... given S 0..* string Given names (not always 'first'). Includes middle names
..... prefix S 0..* string Parts that come before the name
..... suffix S 0..* string Parts that come after the name
..... period S 0..1 Period Time period when name was/is in use
.... telecom S 0..* ContactPoint Contact details (telephone, email, etc.) for a contact
..... Slices for extension Content/Rules for all slices
...... extension:contactpoint-availabletime S 0..* ContactPointAvailableTime NDH Contactpoint Availabletime
...... extension:via-intermediary S 0..1 ViaIntermediary NDH Via Intermediary
..... system S 0..1 code phone | fax | email | pager | url | sms | other
..... value S 0..1 string The actual contact point details
..... use S 0..1 code home | work | temp | old | mobile - purpose of this contact point
..... rank S 0..1 positiveInt Specify preferred order of use (1 = highest)
... endpoint S 0..* Reference(National Directory API Endpoint Profile) Technical endpoint
... network 0..* Reference(National Directory API Network Profile) What networks are Included
... coverage S 0..* BackboneElement Coverage details
.... type S 1..1 CodeableConcept Type of coverage
.... network 0..* Reference(National Directory API Network Profile) What networks provide coverage
.... benefit S 1..*